1 PRC Prior Authorization Specialist Job in Norman, OK

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PRC Prior Authorization Specialist

Absentee Shawnee Tribe of Indians of Oklahoma

Norman, OK | Full Time

$35k-43k (estimate)

1 Month Ago

PRC Prior Authorization Specialist

$35k-43k (estimate)

Full Time 1 Month Ago

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Absentee Shawnee Tribe of Indians of Oklahoma is Hiring a PRC Prior Authorization Specialist Near Norman, OK

This position is currently open.

Public?:

Internal

Division:

Health

Reports To:

PRC Director

Type of Position:

Regular Full Time

Location:

Little Axe Health Center / 15951 Little Axe Dr. / Norman, OK 73026

General Description

Responsible for completion of prior authorizations, pre-certifications, and notifications for all medical, specialties, pharmaceutical and diagnostic services. Utilizes a thorough working knowledge of insurance plans and benefit structures to obtain detailed benefit information and maximize benefits. Responsible for documenting/providing notifications of delays or denials of pre-authorizations/pre-certification approvals. Responsible for all prior-authorization needed for referrals Tribal, Private Insurance and Indian Health Services (IHS) initiated by Absentee Shawnee Health System providers. Responsible for processing provider driven referrals as assigned by the Case Manager/Department Director.

Responsibilities & Duties

Determine necessity for pre-authorization for in-house and out bound referred services

Knowledge of requirements for prior authorizations including procedures, specialist, and medications,

Screen patients for available third party resources

Work with insurance to pre-certify/authorize the exams, visits, and prescriptions.

Ensures up-to-date documentation on patient’s accounts in Electronic Medical System on authorization approvals and denials. (Including approval dates, prior authorization number in patient profile.)

Review accuracy and completeness of information requests and ensure that they are properly and closely monitored.

Submit clinical supporting documentation to Insurance carriers to expedite prior authorization processes.

Manage correspondence with insurance companies, physicians and patients as required -AST, PVT Insurance and IHS

Look through denials and submit appeals to get them approved from insurances.

Proactively work on prior authorizations that are due to be expired.

Secure patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPPA compliance and regulations.

Ability to work independently with minimal supervision.

Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.

Stay up to date on FDA authorization criteria for medications, relay these requirements to providers

Clinical knowledge to be able to answer all clinical questions.

Performs other duties as assigned.

Qualifications

Education and Qualifications

Education: High School Diploma / Some College Preferred

Knowledge of CPT, HCPCS, ICD-10 codes

Ability to produce detailed work accurately and efficiently

Ability to work with sensitive and confidential information

Strong organizational skills

Customer Service experience

Basic computer skills

Must possess a valid Oklahoma Driver’s License

Preferred Qualifications:

Previous experience working with a Native American entity.

Certified Medical Assistant

Experience in completing Prior Authorizations

Completion of Medical Terminology Course

Physical Requirements and Working Conditions

Must be able to sit, stand, stoop, bend or kneel for long periods of time.

Sitting or standing or walking for long period of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking hearing and visual acuity.

Frequent lifting (up to 15 lbs)

Occasional lifting (up to 30 lbs)

The Absentee Shawnee Tribe of Oklahoma (AST) is committed to Equal Employment without regard to race, religion, color, gender, national origin, age, disability, or sexual orientation. However, in accordance with the Indian Preference Act (Title 25 U.S. Code 472 and 473) preference in filling vacancies are given to qualified Indian candidates. AST will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990 and its amendments.

Native American Preference/EEO/Drug Free/Smoke Free Workplace

Posted Date:

1 day 12 hours ago

Closing Date:

Sunday, June 2, 2024

Tribal Preference/Native American Preference/EEO/Smoke Free/Drug Free Workplace
Indian preference applies to all positions, but all resumes will be accepted.

Forward Completed Absentee Shawnee Tribe applications with resume to:
Absentee Shawnee Tribe
Human Resources Department
2025 South Gordon Cooper Dr.
Shawnee, OK 74801
Fax: 405-273-2710
Email: HR@astribe.com